As shocked as all sensible people are at the revelations that members of the previous administration* sold out the lives of hundreds of thousands of their fellow citizens for three points in a Gallup poll in Iowa, we may have forgotten that the Republican Party’s willingness to sacrifice American lives for cheap political purposes is yet another thing that didn’t start with the previous president*. In the July issue of the Journal of Health Economics, there is a detailed study of the public health effects of the FREE MONEY! forMedicaid expansion available to the states through the Affordable Care Act. As you might have guessed, the effects were quite good, both as far as public health and the economy.
We find a reduction in all-cause mortality in ages 20 to 64 equaling 11.36 deaths per 100,000 individuals, a 3.6 percent decrease. This estimate is largely driven by reductions in mortality in counties with higher pre-expansion uninsured rates and for causes of death likely to be influenced by access to healthcare. A cost-benefit analysis shows that the improvement in welfare due to mortality responses may offset the entire net-of-transfers expenditure associated with the expansion.
So accepting the FREE MONEY! worked, especially for those places with a high number of uninsured people prior to the passage of the act. People got healthier. People were relieved of the stress and doubt that can consume you if you’re choosing between food and medicine, let alone a visit to a doctor. The governors who accepted the FREE MONEY! for their states did a vast amount of good for their constituents. Then, of course, there were all those Republican governors who refused the FREE MONEY! because freedom. Scott Lemieux at Lawyers, Guns, and Money has been good on explaining how Chief Justice John Roberts rewrote the ACA to make it easier for governors to turn down the FREE MONEY! Worse, since the initial passage of the bills, several states have passed referenda mandating that their states accept the FREE MONEY!, only to have Republican governors and/or Republican majorities in their state legislatures monkey-wrench the process of enacting the clear will of their voters.
In Missouri, Governor Mike Parson refused to enact a voter-approved expansion until the state supreme court hit him over the head. In Kansas, Democratic Governor Laura Kelly keeps trying to include the expansion in her state budget, only to be thwarted by the legislature. In North Carolina, Democratic Governor Roy Cooper wound up in a budget impasse two years ago because he tried to include the expansion in his budget. And then there’s Wisconsin. From the Kaiser Family Foundation:
After the Wisconsin Legislature’s Joint Finance Committee voted to remove Medicaid expansion funding from Democratic Governor Tony Evers’ State Fiscal Years (SFY) 2022-2023 budget proposal, Governor Evers signed an executive order to hold a special session for Medicaid expansion legislation on May 25, 2021, proposing to use the additional federal funds the state could receive under the incentive in the American Rescue Plan Act for other state development projects. However, on May 25, the Republican-controlled legislature adjourned the special session without further action, and the legislature passed a SFY 2022-2023 budget without Medicaid expansion funding on June 30. The governor had included Medicaid expansion in his previous budget proposal for FY 2020-2021, but the Republican-controlled legislature did not include it in the final budget. Wisconsin covers adults up to 100% FPL in Medicaid but did not adopt the ACA expansion.
Despite being hamstrung by Roberts’ meddling, and by Republican political idiocy, the Medicaid expansion is the part of the the ACA that has worked best at what it was designed to do. It is the best argument for the law there is. And the data is now rolling in. Governors who have taken the FREE MONEY! have helped their constituents live healthier and more productive lives. The governors and state legislators who have refused it simply don’t care about doing that.
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